Relationship Between Diurnal Blood Pressure Rhythm and Prognosis after Percutaneous Coronary Intervention for Hypertension Complicated with Acute Coronary Syndrome
Objective:To investigate the relationship between circadian rhythm of blood pressure and prognosis after percutaneous coronary intervention(PCI) in patients with hypertension complicated by acute coronary syndrome.Methods:Patients with hypertension combined with acute coronary syndrome admitted to our hospital from September 2018 to August 2019 were retrospectively selected and divided into poor prognosis group(30 cases) and good prognosis group(80 cases) according to the occurrence of postoperative adverse cardiovascular events. Dynamic blood pressure indexes of patients after PCI were compared between the two groups. Univariate and multivariate analysis of risk factors affecting the occurrence of postoperative adverse cardiovascular events. Chi-square automatic Interactive detection ( CHAID) classification tree algorithm was used to construct the risk prediction model of postoperative adverse cardiovascular events,and the benefit chart and index chart were used to evaluate the clinical application value of the model.Results:Night systolic blood pressure(SBP) and diastolic blood pressure(DBP) in poor prognosis group were significantly higher than those in good prognosis group,and the reduction rates of night SBP and DBP were significantly lower than those in good prognosis group,the difference was statistically significant(P<0.05).Smoking,non-dipping blood pressure,multiple coronary artery lesions,and ≥3 stents implantation were independent risk factors for postoperative adverse cardiovascular events(P<0.05).The results of classification tree model showed that among the four explanatory variables of smoking,type of hypertension,number of coronary artery lesions,and number of stent implantation,type of hypertension had the greatest influence on postoperative adverse cardiovascular events.Both gain plots and index plots showed that the model was effective in predicting adverse cardiovascular events.Conclusion:The diurnal blood pressure rhythm disappeared after PCI in patients with hypertension and acute coronary syndrome,which was manifested as increased nocturnal blood pressure and decreased nocturnal blood pressure drop rate. The disappearance of circadian blood pressure rhythm is likely to cause postoperative adverse cardiovascular events,which is not conducive to the prognosis of patients.
万方数据
维普
